What would you ask an expert in pediatric trauma?
I ended up at a lunch with two respected pediatric trauma experts. One was a physician, and the other a nurse. Both hold influential positions in their facilities, and have been in the business of pediatric trauma for years.
I wanted to pick their brains for hours and discover some hidden clinical gem that I could pass on to my friends in EMS. Ideally, look to find something we could DO to impact care on critical kids. But, time was short, so I settled on asking them one question.
“What would you tell us EMS folks to START doing with critical kids that you see that we are currently NOT doing?”
They almost answered in unison. “Be more aggressive in fluid resuscitation.”
Turns out, we’re the “goalie.” Our job is to prevent the kid from falling off the shock cliff by recognizing tachycardia as the warning sign. In essence, we need to grab the ball and throw it FAR into the playing field in order to give the child the best chance to survive. We “throw the ball” by being aggressive with fluid resuscitation.
20mL/Kg fluid bolus, repeat if necessary. If the child is between 1-10 years old, maintain systolic pressure of 70+(2 x age in years). Under one year-olds? Keep the systolic in the 60-70 range, but always watch for tachycardia.
A good reminder to stick to the basics; as it turns out they are pretty important, and it is something we can easily do.